“My friend Jenny is a patient of yours. She said if I ate like you’ve been telling her to, I’d lose weight just like her. I’m glad she’s down 27 pounds, but …”Leslie continued, “I expected to lose more than this. I’m eating less than a thousand calories a day and I’m still at 180 pounds. I just don’t understand.”
Glancing at Leslie’s intake forms I saw that indeed another patient of mine referred her to me. “I’ve gotten a reputation as a ‘diet cleaner upper’, so many of my new patients come to me as you are now, with their diet already cleaned up. Don’t worry, I see quite a few people who have had, let’s say, underwhelming results with diet and exercise.”
I continued gathering my history, “You feel cold a lot?”
“Yes.”
“Constipated?”
“I go every other day.”
“I’m seeing a pattern here. Your medical history strongly suggests that you have hypothyroidism. That’s a big cause of a slow metabolism.”
“I ask my GP to check that all the time. But my tests always come back normal.”
“Thyroid tests sometimes can be confusing and difficult to interpret. Before we say for sure whether you do or do not have a thyroid problem, let’s check a more comprehensive panel. In the meantime, here’s an article on thyroid testing, so you can better understand the results when they come back.”
Leslie returned two weeks later. “Please don’t tell me my labs are normal.”
I smiled. When patients go to their GP for an annual physical, they just want their tests to be normal. When they come to see me, however, they want me to find what’s wrong with them. “Not this time. Your thyroid definitely is not working correctly.”
“Why didn’t my other doctors find this?”
“As I said before, thyroid testing is tricky, and what makes your condition harder to diagnose is that you have a unique thyroid problem called CENTRAL HYPOTHYROIDISM. Let me explain:
“Most doctors only check the TSH, a negative feedback test of thyroid function is low. It works like a thermostat, so if it is high, we feel that your body is asking for a lot more thyroid hormone to be produced, but isn’t able to meet that demand.”
“I’m so cold right now, so my TSH must be high then?”
“No. Your TSH is actually on the low side at 0.35 with the normal range reported between 0.5 and 5.5.”
“But you said I was low thyroid? With a low TSH, I would be having too much thyroid hormone in my body. This doesn’t make sense.”
“It would be confusing if I stopped right there, but I also tested for the amount of active thyroid hormones in your body. The Free T4 and Free T3 tests measure thyroid hormone that has four and three iodine atoms on them respectively. The range for the Free T4 is 0.8 to 1.8 and you’re only at 0.8. For Free T3, normal is 230 to 420. You’re on the low side again, at 236. You don’t have much thyroid hormone in your body at all.”
“So what does this all mean?”
“Low thyroid concentrations translate to constipation, cold intolerance, and in general, a low metabolism. But when you have a low TSH your body doesn’t ask your thyroid to produce more thyroid hormone. So, you’re left with a low metabolism that prevents you from losing weight. With Central Hypothyroidism, the TSH is not accurate.”
“I think I get it now. But, Dr. Woliner, why didn’t my other doctors do those tests?”
“Perhaps it is because they are too rushed, double-booking 15-minute time slots. By scheduling longer appointments with my patients, I have time to think about my patients’symptoms and arrive at a better diagnosis. Irregardless, we now have a reason why a low-calorie diet alone has not resulted in weight loss for you.”
“So what do we do now? You’re going to prescribe something?”
“Thyroid medications are not weight loss medications so you will still need to continue the good diet and exercise regimen you’ve started on. But yes, I am going to prescribe Natural Desiccated Thyroid (NDT) to replace the T4 and T3 you’re missing. Let’s start with a low dose and adjust from there as needed.”
Leslie was ecstatic three months into her new treatment protocol.
“Dr, Woliner, can you believe I’m down three dress sizes? I think my husband is happier than me. He can’t wait to show me off at the black tie event we have this weekend!”
